MEDICARE: LIFE SKILLS CENTER FOR ADULTS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251C00000X	Developmentally Disabled Services Day Training Agency

General Provider Information

NPI Number	:	1871924993
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIFE SKILLS CENTER FOR ADULTS

Provider Business Mailing Address
First Line	:	328 E CAMP WISDOM RD
Second Line	:
City	:	DUNCANVILLE
State	:	TX
Zip	:	75116-2706
Country	:	US
Telephone Number	:	972-709-3448
Fax Number	:	972-709-3451

Provider Business Practice Location Address
First Line	:	328 E CAMP WISDOM RD
Second Line	:
City	:	DUNCANVILLE
State	:	TX
Zip	:	75116-2706
Country	:	US
Telephone Number	:	972-709-3448
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	TELESE CLARKE
Credential	:
Telephone Number	:	972-709-3448

Provider Enumeration Date	:	11/30/2013
Last Update Date	:	02/10/2025

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